Title : Long-term results of concomitant stentless aortic root replacement and reconstruction of the ascending aorta
Purpose. Concomitant ascending aortic aneurysm and aortic valve disease is common in bicuspid aortic valve or in older patients with degenerative valve disease and hypertension. Bioprosthetic aortic root replacement can be combined with a traditional ascending graft for concomitant aortic root and ascending aorta reconstruction for simultaneous treatment of all existing pathology.
Methods. One hundred consecutive patients underwent elective concomitant aortic root replacement with a Medtronic Freestyle© © bioprosthesis and ascending aorta reconstruction with a prosthetic graft during a 17-year period. Indications for root replacement were dilation of all three aortic sinuses, small aortic root, or failed prior root replacement. Patients were followed with scheduled clinic evaluation and transthoracic echocardiography.
Results. There was one operative mortality and one permanent neurologic complication. Mean length of follow-up was 5.2 years (range 1 week to 14.9 years). There was no valve-related mortality or death attributable to aortic disease. Freedom from thromboembolism, endocarditis, and reoperation for valvular disease was 97%, 98%, and 93%, respectively. At last follow-up, 6 patients required reintervention; 2 for endocarditis, 3 for structural valve dysfunction and 1 for pseudoaneurysm. Four of these patients underwent successful transcatheter valve replacement and two patients required redo mechanical valve replacement. Echocardiography was performed at a mean of 4 years (range 1 week to 14 years). Mean and peak gradients were 5 mmHg (range 2 to 14) and 9 mmHg (range 2 to 30), respectively. One patient developed valve thrombosis which was successfully treated with anticoagulation. No patient has developed permanent valve-related impairment or additional aortic pathology.
Conclusions. Concomitant Freestyle© aortic root replacement and ascending aortic reconstruction is a safe and effective approach that eliminates both valvular and aortic pathology, and may subsequently reduce the incidence of reoperation for either disease. We recommend prompt intervention for such patients when appropriate criteria are met for either valvular or aortic indications.
Audience Take Away
- This paper demonstrates safe and effective use of stentless biologic prostheses for reconstruction of the aortic root and ascending aorta
- This operation provides durable treatment for patients with aortic root and ascending aneurysms.
- Other institutions can readily adopt this approach for aortic patients.
- This surgical technique cures both aortic root and ascending aneurysm disease in a single operation.